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Map Quiz
Map Quiz

Patient Assess (Scene Size up and Primary)

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Patient Assess (Scene Size up and Primary)

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About this activity

Can you identify where all the points go when presented in random order?

Created by

Leila Durch-Anderson
Leila Durch-Anderson
United States

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Patient Assess (Scene Size up and Primary)
 

Patient Assess (Scene Size up and Primary)Online version

Can you identify where all the points go when presented in random order?

by Leila Durch-Anderson
1 Scene Size Up 2 Scene Safety 3 # of Patients 4 Additional Resources 5 General Impression 6 MOI (c-spine) or NOI 7 Primary Assessment 8 Chief Complaint/Level Of Consciousness 9 AVPU, PPTE, GCS 10 Airway 11 Breathing 12 Breathing tips 13 Circulation 14 Priority and Transport Decision

Explanation

This starts on the way to the call (ALS, flight, etc can't teleport there in an instant. So start resources early if they might be needed. They can always be cancelled later).

Dynamic and never ending. This can include PPE but also, scenes can become volatile in an instant. Keep your head on a swivel and be aware of your surroundings.

If multiple patients are suspected, what is the game plan between you and your partner/crew? Who's walking the scene and taking a head count? Who's triaging? Who's treating? Who's the senior provider and what should they do vs the newbie?

How long will it take for ALS/Flight/PD/Fire to reach you? Start them early to reduce delays, they can always be cancelled later. Do you know if there is a local hazmat team and how to activate them? Who deals with downed powerlines on scene and how do you request them? These are things to consider BEFORE you run a call where you may need them.

What did your highly tuned and refined instincts say when you laid eyes on the patient? Essentially, did you notice any immediately obvious life threats? What visual, and sometimes auditory, cues lead you to this conclusion of the patient being stable/unstable?

Remember, c-spine can be delegated to your partner until such a time that it is appropriate to rule it in/out.

This is the point of direct contact/interaction with the patient. The goal now is to quickly identify and treat life threats first.

Chief complaint can be what the patient states, and/or the life threat noted.

AVPU (are they ALERT? Responsive to VERBAL stimuli, responsive to PAINFUL stimuli, or UNRESPONSIVE). If they are alert, are they also oriented to PPTE? Are they alert but confused? Alert but oriented to baseline, such as in the case of dementia or special needs patients? Don't forget to add up your Glasgow Coma Scale.

Is there airway open? Do you need to head-tilt-chin-lift or jaw-thrust? Is the airway clear/patent?

Do they need oxygenation? Ventilation? What are their lung sounds?

Options that can be included in breathing assessment are: breath sounds (4 quadrants), SPO2, ETCO2, equal chest rise and fall

Unresponsive: feel for a carotid. Responsive: feel for a radial. Control major bleeding. Asses skin for color, temp, and moisture.

Is the patient a high or low priority? Another way to phrase it is "load and go, or stay and play".

 
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